IS AMBULATORY ELECTROCARDIOGRAPHY USEFUL IN THE EVALUATION OF PATIENTS WITH RECENT STROKE

This study was designed to determine whether ambulatory electrocardiog raphy in patients with recent stroke would lead to a change in clinica l management or outcome and to express these findings in terms of cost benefit. A prospective, consecutive sample of patients (n=100) with r ecent stroke referred from the neurology or medical services for ambul atory electrocardiography was identified. Ambulatory electrocardiogram s were reviewed to identify patients with potentially important bradya rrhythmias, tachyarrhythmias, or atrial fibrillation, Patients were th en followed up without interference with ongoing care to determine whe ther these findings led to changes in clinical management that might i nfluence patient outcome. Of the 100 patients, 16 had an index ''impor tant'' arrhythmia. No significant bradyarrhythmias were noted. Nonsust ained ventricular tachycardia (greater than or equal to 6 complexes) i n two patients and supraventricular tachycardia (greater than or equal to 10 complexes) in seven patients did not lead to management changes . Four patients had a history of atrial fibrillation who were in sinus rhythm; anticoagulation had been addressed in three; the fourth patie nt died before the issue could be addressed. Of three patients in atri al fibrillation, there was a history of atrial fibrillation and a deci sion regarding anticoagulation in each before monitoring. The cost of these 100 ambulatory electrocardiograms was about $55,000, In conclusi on, these findings do not support the routine use of ambulatory electr ocardiography in the evaluation of patients with stroke.